Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study

Boveda, Serge; Marijon, Éloi; Jacob, Sophie; Defaye, Pascal; Winter, Jobst B.; Bulava, Alan; Gras, Daniel; Albenque, Jean Paul; Combes, Nicolas; Pavin, Dominique; Delarche, Nicolas; Teubl, Alexander; Lambiez, M.; Chevalier, Philippe

doi:10.1093/eurheartj/ehp071

Cited by 27 publications

(11 citation statements)

References 26 publications

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“…Again, our results corroborate those findings. There were only two presumed sudden cardiac deaths over a period of one year in the 198 CRT-P patients naïve to cardiac pacing included in the Mona Lisa study (9). A different study reported a 1.9% risk of sudden cardiac death per year in CRT-P patients previously naïve to cardiac pacing (24).…”

Section: Main Findingsmentioning

confidence: 99%

“…On one hand, the majority of CRT upgrades are performed in patients with an LV ejection fraction <35%, thus fulfilling ICD implantation criteria according to the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) (7). On the other hand, some studies suggested that de novo CRT-P patients and those upgraded from pacemaker to CRT-defibrillator (CRT-D) have a low annual risk of sustained ventricular arrhythmias and sudden cardiac death (8)(9)(10). In addition, chronically RV paced heart failure patients may respond even better to CRT with greater improvements in ejection fraction and intraventricular dyssynchrony than heart failure patients without RV pacing (11).…”

Section: Bradycardia Indications Who During Follow-up Develop Severmentioning

confidence: 99%

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Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

et al. 2016

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Aims: Upgrade to cardiac resynchronization therapy (CRT) should be offered to patients who have developed pacing-induced cardiomyopathy with conventional right ventricular pacing. The extent to which those patients would also benefit from defibrillator back-up at the time of CRT upgrade is, however, unknown. Methods:Retrospective observational cohort study of 199 patients with pacing-induced cardiomyopathy (without history of sustained ventricular arrhythmia), including 104 upgraded to CRT-Pacemaker (CRT-P) and 95 upgraded to CRT-Defibrillator (CRT-D). The incidence of ventricular arrhythmias and, through a cause-of-death analysis based on clinical data and necropsy results, the risk of sudden arrhythmic death were assessed and compared between the two groups.Results: During a mean follow-up of 66±24 months, 40 (38.5%) CRT-P patients died: three from primary arrhythmic death, while the remaining died of different causes (especially progressive heart failure), giving an incidence of 6.2 sudden arrhythmic deaths per 1000 patient-years. No episode of sustained VT was observed in the study group. There were no sudden arrhythmic deaths in the CRT-D group during a shorter follow-up, but the small and non-significant difference in all-cause mortality between CRT-P and CRT-D groups was mostly accounted for by an increase in non-sudden death. Women upgraded to CRT were at particularly low risk of all-cause mortality compared with men (HR 0.232, p=0.048). Conclusion:Our findings suggest that patients who develop pacing-induced cardiomyopathy and are upgraded to CRT may not derive any significant benefit from the addition of the defibrillator in the absence of a history of ventricular arrhythmias. 3 KEYWORDSCardiac resynchronization therapy; pacemaker; implantable cardioverter-defibrillator; ventricular arrhythmias; cause-of-death; sudden arrhythmic death. 4 CONDENSED ABSTRACTIn our retrospective cohort study of 199 patients with pacing induced cardiomyopathy submitted to CRT upgrade, we have found that the risk of sustained ventricular tachycardia or sudden arrhythmic death is very low, and any increased mortality risk in those receiving CRT-P compared with CRT-D is mostly accounted for by an increase in non-sudden death. 5 WHAT'S NEW? Our study provides the largest and longest-term cause-of-death analysis in patients with pacing-induced cardiomyopathy based on post-mortem examinations and death certificates. We have found that the annual risk of sudden arrhythmic death or sustained ventricular arrhythmias in these patients is very low, and similar to a control group implanted with CRT with a defibrillator.  The small difference in all-cause mortality between CRT-Pacemaker and CRTDefibrillator in patients with pacing-induced cardiomyopathy is mostly accounted for by an increase in non-sudden death. Our results suggest that an upgrade to CRT-Defibrillator in patients with pacinginduced cardiomyopathy may convey no additional benefit when compared with upgrade to CRT-Pacemaker, and the cost-effectiveness ratio of...

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Section: Main Findingsmentioning

confidence: 99%

Section: Bradycardia Indications Who During Follow-up Develop Severmentioning

confidence: 99%

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

et al. 2016

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“…6–11 The following parameters may warn of impending ADHF or other cardiovascular events and predict poor clinical outcome: (i) sustained decrease in thoracic impedance due to lung fluid retention 5–8,12–15 (measured between a lead in the right ventricle and the generator in the left pectoral region or using alternative current pathways); 16–18 (ii) low heart rate variability, indicating sympathetic dominance in cardiac autonomic control; 6,7,12,19–22 (iii) a high resting heart rate or relatively high mean heart rate over 24 h; 6,19,21,23–25 (iv) decreased patient activity, potentially reflecting exercise intolerance; 7,12,19–21 (v) increased frequency of ventricular extrasystoles; 26 (vi) ventricular tachyarrhythmia episodes or defibrillation shocks; 7,27,28 (vii) prolonged duration of atrial fibrillation; 7,21,22 (viii) rapid ventricular rate during atrial fibrillation; 7,21 (ix) reduced cardiac resynchronization pacing percentage, indicating a failure in the electrical treatment of cardiac asynchrony; 7,29 (x) minute ventilation disturbances; 30 and (xi) haemodynamic deterioration monitored with impedance-based or pressure sensors. 8,16,18,31,32 Combining several of these parameters into a single algorithm may improve the overall ability to risk-stratify patients with implanted devices.…”

Section: Introductionmentioning

confidence: 99%

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home‐CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

Sack

Wende

Nägele

et al. 2011

European J of Heart Fail

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AimTo investigate whether diagnostic data from implanted cardiac resynchronization therapy defibrillators (CRT-Ds) retrieved automatically at 24 h intervals via a Home Monitoring function can enable dynamic prediction of cardiovascular hospitalization and death.Methods and resultsThree hundred and seventy-seven heart failure patients received CRT-Ds with Home Monitoring option. Data on all deaths and hospitalizations due to cardiovascular reasons and Home Monitoring data were collected prospectively during 1-year follow-up to develop a predictive algorithm with a predefined specificity of 99.5%. Seven parameters were included in the algorithm: mean heart rate over 24 h, heart rate at rest, patient activity, frequency of ventricular extrasystoles, atrial–atrial intervals (heart rate variability), right ventricular pacing impedance, and painless shock impedance. The algorithm was developed using a 25-day monitoring window ending 3 days before hospitalization or death. While the retrospective sensitivities of the individual parameters ranged from 23.6 to 50.0%, the combination of all parameters was 65.4% sensitive in detecting cardiovascular hospitalizations and deaths with 99.5% specificity (corresponding to 1.83 false-positive detections per patient-year of follow-up). The estimated relative risk of an event was 7.15-fold higher after a positive predictor finding than after a negative predictor finding.ConclusionWe developed an automated algorithm for dynamic prediction of cardiovascular events in patients treated with CRT-D devices capable of daily transmission of their diagnostic data via Home Monitoring. This tool may increase patients’ quality of life and reduce morbidity, mortality, and health economic burden, it now warrants prospective studies.ClinicalTrials.gov NCT00376116.

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“…The implantation technique has already been described. 14 Because of procedural difficulties, only 74 of the 86 included patients could benefit from the implantation of a left ventricular lead. The patients in whom we failed to implant a left ventricular lead (ie, in whom resynchronization therapy could not be achieved) were not followed up.…”

Section: Methodsmentioning

confidence: 99%

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

Dauphin

Nonin

Bontemps

et al. 2011

Circ: Cardiovascular Imaging

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Background-Phase analysis, developed to assess dyssynchrony from ECG-gated radionuclide ventriculography, has shown promising results. We hypothesized that quantifying the cardiac resynchronization reserve, that is, the extent of response to cardiac resynchronization therapy (CRT), by radionuclide imaging could potentially identify patients who are best suited for CRT. Methods and Results-Seventy-four patients ages 64.8Ϯ10.1 years were prospectively studied from July 2004 to July 2006, of whom 62.2% and 37.8%, respectively, were in New York Heart Association class 3 and 4. Mean QRS width was 173Ϯ25 ms. ECG-gated radionuclide ventriculography to quantify interventricular and intraventricular dyssynchrony was performed at baseline with and without CRT and at the 3-month follow-up visit. Amino-terminal-pro-brain natriuretic peptide (NT-pro-BNP) levels were also determined at baseline and at 3 months. During a mean follow-up of 10.1Ϯ7.6 months, there were 37 (50%) clinical events that defined the nonresponder group, including cardiac death or readmission for worsening heart failure. In multivariate Cox model analysis, higher NT-pro-BNP blood levels were associated with a significant increase in the risk for event (hazard ratioϭ1.085 for a 100 pg/L increase in NT-pro-BNP; 95% confidence interval, 1.014 to 1.161). Each 10°elevation in intraventricular dyssynchrony was associated with a decrease in the risk of events (hazard ratioϭ0.456, 95% confidence interval, 0.304 to 0.683). Receiver operating characteristic curve analysis demonstrated that an interventricular dyssynchrony cutoff value of 25.5°for intraventricular synchrony yielded 91.4% sensitivity and 84.4% specificity for predicting a good response to CRT. Conclusions-The

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Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study

Cited by 27 publications

References 26 publications

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

Patients upgraded to cardiac resynchronization therapy due to pacing-induced cardiomyopathy are at low risk of life-threatening ventricular arrhythmias: a long-term cause-of-death analysis

Potential value of automated daily screening of cardiac resynchronization therapy defibrillator diagnostics for prediction of major cardiovascular events: results from Home‐CARE (Home Monitoring in Cardiac Resynchronization Therapy) study

Quantification of Ventricular Resynchronization Reserve by Radionuclide Phase Analysis in Heart Failure Patients

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